Application for the Disabled Students’ Allowance (DSA) for eligible students who are claiming DSA funding only 2021-2022 The closing date for applications is 31st March 2022 Section A – reference number Have you previously applied for an award from us (including a fees only award)? If you answered ‘Yes’, please give your SAAS reference number Yes X No X Cross (x) one box only Use the eight digit number on your letter of award Postgraduate students (you must fill in this section) Will you receive, for the academic year 2020-2021 a bursary or other award from a Research Council or any other UK publicly funded award making body? Yes No If you answered ‘Yes’, you will not be eligible to apply for the Disabled Students’ Allowance from us. Do not continue with this application. Instead you should contact your funding body to discuss making an application to them. You should fill in this form if you have a disability and have extra costs while you study. Fill in the form in CAPITAL letters using black ink. There are notes to help you fill in the form. You can download these from the ‘forms and guides’ section of our website. If you need more information, you can visit our website at www.saas.gov.uk, e-mail us at [email protected] or call us on 0300 555 0505. You can get a version of our DSA literature in a format that suits your needs. Contact us on 0300 555 0505. Data Protection SAAS will use the information you have given us in this form for the purpose of processing this claim. Further information on how we collect, hold and process your information can be found at the end of this form in the SAAS basic privacy statement. The full SAAS privacy statement can be found at https://www.saas.gov.uk/data-protection. We have a duty to appropriately manage public funds and we will use the information provided on this form for the prevention, detection, investigation and reporting of crime, including Fraud. We will share this information with other bodies for these purposes. 1 Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT t / 0300 555 0505 w / www.saas.gov.uk DSA only application Who should fill in this form? (If you are not sure what form to fill in please read our DSA notes.) Full-time students You should fill in this form if you meet our residence eligibility conditions (see the DSA notes) and you are doing a full-time:  undergraduate course that we support, for example, an HNC, HND, degree or equivalent qualification, but we are not paying your fees and you do not want to apply for a bursary, student loan or living-costs grants; or  postgraduate course and you are not receiving a tuition fee loan from us. Part-time students You can fill in this form if you meet our residence eligibility conditions (see the DSA notes) and you are:  working towards at least 50% of a full-time higher education qualification that we support. For example, an HNC, HND, degree or an equivalent qualification. Or you are working towards at least 50% of a full-time postgraduate qualification. For Open University students, this means at least 60 credits in each academic year; and  following a programme of study which lasts for more than one academic year but not more than twice the period normally needed to complete a full-time equivalent qualification. 2 Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT t / 0300 555 0505 w / www.saas.gov.uk DSA only application Section B – your personal details Are you studying full-time? part-time? distance learning? National Insurance number (you must enter this if you have one). Title Mr Mrs X Ms X X Miss If Other (please specify) X First names Last name Name at birth, if different from above Date of birth D D / M M / Y Y Y Y If you have a UK birth certificate, in which district was it issued? Full address and postcode of your permanent home (you must enter this). Telephone number (including area code) Mobile phone number Email address Full address and postcode of your term-time address (if this is not the same as your permanent home address) (you must enter this) Bank details – please note we cannot pay any DSA without a valid bank or building society account. Sort code - - Account number 3 Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT t / 0300 555 0505 w / www.saas.gov.uk DSA only application 4 Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT t / 0300 555 0505 w / www.saas.gov.uk DSA only application Section C – Your disability or le

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